neonatalEmergencies - NeonatalEmergencies...

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Neonatal Emergencies Neonatal Emergencies Joy Loy MD March 2009
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1.discuss the underlying pathophysiology of selected neonatal emergencies, 2.explain the anesthetic implications and 3.describe safe anesthetic plans for each. Objectives Objectives Participants will be able to Participants will be able to
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Maternal and perinatal history Recreational drug use Birth history Minimum labs: glucose and CBC Look for associated anomalies Cardiac and respiratory status Metabolic and electrolyte imbalance Hydration status Coagulation profile IV access Preoperative Evaluation Preoperative Evaluation
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Pyloric Stenosis Pyloric Stenosis
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Pyloric Stenosis Pyloric Stenosis Most common GI obstructive anomaly in neonates Hypertrophy of the muscular layer of the pylorus A medical emergency but not a true surgical emergency Incidence: 1 – 3 :1,000 live births 2 - 5x more common in first born, M > F (4:1)
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Pyloric Stenosis Pyloric Stenosis Etiology : unknown ? acquired condition with hereditary predisposition Symptoms are apparent between 2 nd -6 th wk of life Presents with nonbilious projectile vomiting, signs of dehydration, jaundice (2%)
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Pyloric Stenosis Pyloric Stenosis Physical Exam visible gastric peristalsis palpable “olive-shaped” mass to the right of the epigastric area signs of dehydration Labs: CBC serum electrolytes EKG ABG BUN
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Pyloric Stenosis Pyloric Stenosis Diagnosis history and physical exam abdominal ultrasound upper GI series with barium contrast not recommended pathological pyloric wall thickness ≥ 4 mm pyloric length of > 16 cm
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Pyloric Stenosis Pyloric Stenosis Metabolic Abnormalities hyponatremia hypochloremia hypokalemia 1° metabolic alkalosis compensatory respiratory acidosis paradoxical acidic urine
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Preoperative Preparation supportive treatment surgical management check lab indices for safe anesthesia Pyloric Stenosis
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Pyloric Stenosis Pyloric Stenosis Preoperative Preparation Preoperative Preparation Supportive therapy Correction of fluid deficits maintenance: D 5 0.2% NaCl + KCl 20 - 40 mEq/L replacement: LR, albumin, normal saline Correction of electrolyte imbalance Prevention of aspiration : NGT
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Pyloric Stenosis Pyloric Stenosis Surgical Management Pyloromyotomy definitive treatment open or laparoscopic Lab indices for safe anesthesia serum Cl >100 mEq/L HCO3 < 28 mEq/L
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Pyloric Stenosis Pyloric Stenosis Anesthetic Concerns pulmonary aspiration severe dehydration metabolic alkalosis
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Pyloric Stenosis Pyloric Stenosis Intraoperative Management Intraoperative Management Monitors : ASA standard Decompress the stomach GA: Induction: controversial awake intubation rapid sequence IV induction and intubation with cricoid pressure inhalation induction with cricoid pressure ± muscle relaxant
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Pyloric Stenosis Intraoperative Management Cook-Sather, 1998 (CHOP) prospective, nonrandomized study awake vs paralyzed intubation (RSI and MRSI) faster and more successful tracheal intubation with muscle paralysis awake intubation does not protect from bradycardia and desaturation
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This note was uploaded on 12/16/2011 for the course BIOLOGY 101 taught by Professor Mr.wallace during the Fall '11 term at Montgomery College.

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neonatalEmergencies - NeonatalEmergencies...

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